Background: Permanent cardiac pacing is the standard treatment for severe symptomatic bradyarrhythmias and conduction disorders. In low-income countries, access to pacemaker therapy remains limited, and published data are scarce. Objective: To describe the evolution of permanent pacemaker implantation in Togo, analyse patient characteristics, indications, outcomes and complications, and discuss challenges related to a resource-limited setting. Methods: A retrospective descriptive study was conducted in the main cardiology centres in Togo from January 2010 to December 2025. All patients who underwent permanent pacemaker implantation were included. Sociodemographic, clinical, electrocardiographic, technical and outcome data were analysed. Results: A total of 291 patients were included. The mean age was 70.9 ± 12.5 years, with a male predominance. Dyspnoea (58.5%) and syncope (31.3%) were the most common presenting symptoms. High-degree atrioventricular block was the leading indication for implantation. The mean delay between diagnosis and implantation was 38.3 days. Dual-chamber pacemakers accounted for 49% of all implants, with a marked increase since 2022 (81.4%). The overall complication rate was low, with each major complication occurring in less than 3% of cases. Conclusion: Permanent cardiac pacing is feasible and safe in Togo. Despite persistent delays, recent improvements reflect strengthening local expertise. Establishing a national registry and improving financial access to devices are key priorities to optimise care.
References
[1]
Glikson, M., Nielsen, J.C., Kronborg, M.B., Michowitz, Y., Auricchio, A., Barbash, I.M., et al. (2021) 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy. EuropeanHeartJournal, 42, 3427-3520. https://doi.org/10.1093/eurheartj/ehab364
[2]
Kusumoto, F.M., Schoenfeld, M.H., Barrett, C., Edgerton, J.R., Ellenbogen, K.A., Gold, M.R., et al. (2019) 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, 140, e382-e482. https://doi.org/10.1161/cir.0000000000000628
[3]
Bonny, A., Ngantcha, M., Yuyun, M.F., Karaye, K.M., Scholtz, W., Suliman, A., et al. (2020) Cardiac Arrhythmia Services in Africa from 2011 to 2018: The Second Report from the Pan African Society of Cardiology Working Group on Cardiac Arrhythmias and Pacing. EPEuropace, 22, 420-433. https://doi.org/10.1093/europace/euz354
[4]
Mkoko, P., Bahiru, E., Ajijola, O.A., Bonny, A. and Chin, A. (2020) Cardiac Arrhythmias in Low-and Middle-Income Countries. CardiovascularDiagnosisandTherapy, 10, 350-360. https://doi.org/10.21037/cdt.2019.09.21
[5]
Kane, A., Houndolo, R., Adoubi, I., Camara, S., Pessinaba, S. and Sy, K. (2016) Challenges of Permanent Cardiac Pacing in Sub-Saharan Africa: The STIMAFRIQUE Multicentre Study. Cardiologie Tropicale, 143, 21.
[6]
Adoubi, K.A., Coulibaly, I., Ndjessan, J.J., Gnaba, A., Tano, M., Tro, G., et al. (2022) Caractéristiques et évolution des complications de la stimulation cardiaque dans un centre de cardiologie de l’Afrique de Subsaharienne. Annales de Cardiologie et d’Angéiologie, 71, 21-26. https://doi.org/10.1016/j.ancard.2021.01.005
[7]
Kane, A., Sarr, S.A., Ndobo, J.V.D., Tabane, A., Babaka, K., Aw, F., et al. (2019) Cardiac Pacing Challenge in Sub-Saharan Africa Environnement: Experience of the Cardiology Department of Teaching Hospital Aristide Le Dantec in Dakar. BMCCardiovascularDisorders, 19, Article No. 197. https://doi.org/10.1186/s12872-019-1176-2
[8]
Camara, Y., Ba, H.O., Sangaré, I., Thiam, C.A., Sonfo, B., Sidibé, N., et al. (2021) Permanent Cardiac Pacing at Sidi Bocar Sall University Hospital, Kati: Patient Profile and Indications. Health Sciences and Disease, 22, 14-17.
[9]
Dia, K., Sarr, S.A., Mboup, W.N., Diouf, Y., Benghazi, N., Mbaye, A., et al. (2024) Cardiac Pacing: Indications, Modalities, Complications, and Challenges (Results of a Multicenter Cross-Sectional Study in Four Hospitals in Dakar, Senegal). ThePanAfricanMedicalJournal, 49, Article 14. https://doi.org/10.11604/pamj.2024.49.14.43515
[10]
Yayehd, K., Ganou, K., Tchamdja, T., Tété, Y., N’cho Mottoh, M.P., Pessinaba, S., et al. (2011) Management of High-Degree Atrioventricular Block in Lomé, Togo. Méde-cine Tropicale, 71, 637-638.
[11]
Jouven, X., Diop, B.I., Narayanan, K., Adoubi, A., Ba, S.A., Balde, D., et al. (2019) Cardiac Pacing in Sub-Saharan Africa. JournaloftheAmericanCollegeofCardiology, 74, 2652-2660. https://doi.org/10.1016/j.jacc.2019.09.034
[12]
Camara, S., Cheikh, M., Ba, H., Boye, K.I., Barry, F., Eba, A., et al. (2019) Clinical Profile and Follow-Up of Patients with Permanent Pacemakers in Mauritania. Revue Tunisienne de Cardiologie, 15, 170-175.
[13]
Mbaye, A., Fall, M., Ngaïdé, A.A.K.I., N’Diaye, M. and Cissé, A.F. (2016) Cardiac Pacing Practice: A Report of 215 Pacemaker Implantations at the General Hospital of Grand Yoff, Dakar, Senegal. Cardiologie Tropicale, 143, 10.
[14]
Millogo, G.R.C., Seghda, A., Ilboudo, M., Konaté, L., Bassolet, B., Kologo, J.K., et al. (2017) Bilan de cinq ans de stimulation cardiaque dans deux structures hospitalières publiques du Burkina Faso: Expérience d’une collaboration avec deux centres hospitaliers d’Auvergne. Annales de Cardiologie et d’Angéiologie, 66, 255-259. https://doi.org/10.1016/j.ancard.2017.09.018
[15]
Cano Pérez, Ó., Pombo Jiménez, M., Fidalgo Andrés, M.L., Lorente Carreño, D. and Coma Samartín, R. (2017) Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016). RevistaEspañoladeCardiología (EnglishEdition), 70, 1083-1097. https://doi.org/10.1016/j.rec.2017.08.017
[16]
Khurshid, S., Epstein, A.E., Verdino, R.J., Lin, D., Goldberg, L.R., Marchlinski, F.E., et al. (2014) Incidence and Predictors of Right Ventricular Pacing-Induced Cardiomyopathy. Heart Rhythm, 11, 1619-1625. https://doi.org/10.1016/j.hrthm.2014.05.040
[17]
Zhang, X., Chen, H., Siu, C., Yiu, K., Chan, W., Lee, K.L., et al. (2007) New-Onset Heart Failure after Permanent Right Ventricular Apical Pacing in Patients with Acquired High-Grade Atrioventricular Block and Normal Left Ventricular Function. Journal of Cardiovascular Electrophysiology, 19, 136-141. https://doi.org/10.1111/j.1540-8167.2007.01014.x
[18]
Tandon, K., Tate, T. and Kirkpatrick, J.N. (2017) Pacemaker Reuse in Low-Income/Middle-Income Countries: Moral Duty or Dangerous Precedent? Heart, 103, 1846-1847. https://doi.org/10.1136/heartjnl-2017-311572
[19]
VanArtsdalen, J., Goold, S.D., Kirkpatrick, J.N., Goldman, E., Eagle, K. and Crawford, T. (2012) Pacemaker Reuse for Patients in Resource Poor Countries: Is Something Always Better than Nothing? Progress in Cardiovascular Diseases, 55, 300-306. https://doi.org/10.1016/j.pcad.2012.10.002
[20]
Kirkpatrick, J.N., Papini, C., Baman, T.S., Khota, K., Eagle, K.A., Verdino, R.J., et al. (2010) Reuse of Pacemakers and Defibrillators in Developing Countries: Logistical, Legal, and Ethical Barriers and Solutions. HeartRhythm, 7, 1623-1627. https://doi.org/10.1016/j.hrthm.2010.04.027
